C-Spine after a fight

The bottom line is, what can potentially happen to you if you withhold an intervention? This goes for any condition, not just the current SMR debate. Being struck on the mouth with a closed fist, without any other insults, shouldn't hold potential for a C-spine injury. If the pt did a face plant afterwards, or hit the back of their head on a curb, then restiction would be warranted, even if the potential for true spinal injury is quite low.

If you're not clear on what situations would necessitate c-spine precautions, than consult your OMD for a definitive answer.
 
46Young said:
The bottom line is, what can potentially happen to you if you withhold an intervention? This goes for any condition, not just the current SMR debate. Being struck on the mouth with a closed fist, without any other insults, shouldn't hold potential for a C-spine injury. If the pt did a face plant afterwards, or hit the back of their head on a curb, then restiction would be warranted, even if the potential for true spinal injury is quite low.

If you're not clear on what situations would necessitate c-spine precautions, than consult your OMD for a definitive answer.
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Cervical spine precautions would most likely be warranted in a situation like that, but again, it is a case by case basis. Again, the term "fight" can be anything from a suckerpunch or a slap to multiple assailants with baseball bats or worse. There isn't enough information in the original post to make a decision one way or another, but I think we've answered his question if getting hit in the face warrants c-spine every time.
 
EMTinNEPA said:
A couple of watery drunks coming to fisticuffs is major facial or head trauma? As I said, it depends on the patient's presentation. All the OP said was "a fight", nothing in regards to physical findings, chief complaint, anything. And since when do we base medical care on "what ifs"? Call me crazy, but I thought medical care was supposed to be based on evidence (*cough*studies*cough*). In my experience and the experience of many others, spinal immobilization is rarely needed for somebody who got clocked in the kisser by somebody who isn't a professional boxer. And just because I agree with you that most backboarding is unnecessary, then I stole your opinion?
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Well usually things called precautions are based on "what ifs" unless you were there to witness the fight first hand what is not to assume that could have happened?

bar fights are not normally fought with gloves on and often can involve other methods of blunt force trauma besides just a fist.

IE knee,chair,wall,curb,fistpack, parking meter, and the list goes on and on. These are all "what ifs" in the case that you were not there first hand to witness the event.

obviously this is all hypothetical, yet if you were dispatched to such a call would it not be fair to ask yourself the "what ifs"?

just my 2 cents.
 
Rebelw/oaGauze said:
Long time reader, first time post. Big fan of the website and everyone here has provided so much great information. My question is whats everyones feelings on C-Spine precautions on a patient after a fight? They are most often intoxicated and have facial/head trauma so they are instant candidates for C-Spine. Aside from obvious trauma and extreme intoxication, does a collar go on everytime? Just wanted some opinions from all you lords of the streets:)
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"Instant candidates"? No. Not necessarily. There's a whole lot more to it than that. Define facial/head trauma. There is more than one reply here mentioning "depends on the presentation". One way of looking at it is assess your patient. You must look, listen, and feel your patient to determine, according to your protocols, the interventions required.

You never say never. You never say always. Especially when it comes to the human body. Because once you do, you'll find a human body that will prove you wrong. So be careful about using blanket statements. They tend to bite you in places you'd rather not be bitten.
 
I originally posted because ive had this debate with multiple people and wanted to see what you people felt. Obviously if the suspect cannot remember what happened in the fight, has major facial/head trauma (evidence of weapon utilized, large lacs or contusions), witnesses saw a total beat down, or is heavily intoxicated they get a collar. But if they are mildly intoxicated, threw some fists and suffered a broken nose and some lacerations, some people say collar them anyways as a precaution. I guess this was also an indirect way to ask what qualifies as "major" facial/head trauma regarding c-spine.
 
FFMckenzie said:
Well usually things called precautions are based on "what ifs" unless you were there to witness the fight first hand what is not to assume that could have happened?

bar fights are not normally fought with gloves on and often can involve other methods of blunt force trauma besides just a fist.

IE knee,chair,wall,curb,fistpack, parking meter, and the list goes on and on. These are all "what ifs" in the case that you were not there first hand to witness the event.

obviously this is all hypothetical, yet if you were dispatched to such a call would it not be fair to ask yourself the "what ifs"?

just my 2 cents.
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That is what witnesses, bystanders, and questioning the patient are for.
 
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